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General NPI Number Information
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NPI Number | 1730419706
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Entity Type | Organization
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Legal Business Name | EVOLUTION PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 300 N MIDDLETOWN RD STE 2
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City | PEARL RIVER
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State | NY
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Zip | 10965-1295
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Country | US
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Telephone | 845-494-1825
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ROCKFORD DR
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City | WEST NYACK
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State | NY
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Zip | 10994-1212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVA LARINO
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Credential |
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Telephone | 845-494-1825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 030442-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 027446-1
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License Number State | NY
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